Basic Information
| Provider Information | |||||||||
| NPI: | 1144201161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRIGAN | ||||||||
| FirstName: | VERNON | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3799 | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370433799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312458300 | ||||||||
| FaxNumber: | 9312458360 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 DUNLOP LN | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312458300 | ||||||||
| FaxNumber: | 9312458360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 03/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 10268 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 409113275 | 01 | TN | RR MEDICARE | OTHER | 3171374 | 05 | TN | MEDICAID |